medical insurance payment limit is the maximum payment limit of medical insurance: it refers to the maximum amount of medical expenses paid by the basic medical insurance fund to the insured in a medical year.

the maximum payment limit of medical insurance fund refers to the medical expenses that can be paid by the overall fund and exceed the maximum payment limit. The basic medical insurance will not be paid, the scope of severe diseases, uremia dialysis treatment, anti-rejection drug treatment after tissue and organ transplantation, and the maximum payment limit of the overall fund.

The maximum payment limit of the medical insurance fund is the so-called "capping line", which refers to the upper limit of medical expenses that can be paid by the overall fund. If the medical expenses exceed the maximum payment limit, the basic medical insurance will not be paid.

For example, the range of severe diseases: radiotherapy and chemotherapy for malignant tumors, dialysis treatment for uremia, and anti-rejection drug treatment after tissue and organ transplantation. Maximum payment limit of the overall fund: the cumulative maximum payment limit of the overall fund in one year is 7, yuan. Other diseases also have payment limits, and each place is different. You can check with the local social security network or consult a doctor.

At present, the standard is about four times the average salary of employees in last year. If the average salary of employees last year was 1, yuan, the maximum payment limit was about 4, yuan. According to the new medical reform plan, the maximum payment limit of medical insurance for urban workers or residents is gradually increased to about 6 times of the average annual salary of local workers and per capita disposable income, and the maximum payment limit of the new rural cooperative medical system is gradually increased to more than 6 times of the per capita net income of local farmers.

The upper limit of general outpatient service is about 2,; The upper limit of hospitalization is around 3,; Some major diseases are not capped; The general concept is like this, and it varies from place to place. You can consult local hospitals and social security centers for specific policies.

basic medical insurance financing standard for residents: the first grade 51 yuan, in which the individual pays 15 yuan and the government subsidizes 36 yuan; Second-grade 45 yuan, in which the individual pays 9 yuan per person and the government subsidizes 36 yuan per person. Students pay in accordance with the second-class individual payment standard and enjoy the medical insurance benefits of residents with the first-class payment standard. The maximum payment limit of medical insurance fund is 15, yuan, and the hospitalization Qifubiaozhun is a first-class hospital in 2 yuan.

legal basis

article 28 of the social insurance law

medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue shall be paid from the basic medical insurance fund in accordance with state regulations.

article 29

the part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by the social insurance agency, medical institutions and pharmaceutical trading units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places, so as to facilitate the insured to enjoy the basic medical insurance benefits.